ROCHESTER — If you had to choose a nursing home for someone you love, would you choose a facility where 85% of the nursing staff had received flu shots– or a place where only 50% were immunized?

“That’s a key question for patients and families today,” says Mary Flynn, executive director at Rochester Manor Health and Rehabilitation Center in Rochester. Flynn, whose center recently received a deficiency-free rating from the Joint Commission for Accreditation of Healthcare Organizations, credits her center’s flu prevention policies for its strong showing in the survey.

“We have a number of systems in place here to prevent the spread of the flu virus among our staff and residents,” says Flynn, “and we are diligent about following daily anti-flu procedures.”

Caryn Quaker, RN, who heads up Rochester Manor’s flu vaccine program, agrees. Quaker, a clinical reimbursement coordinator at Rochester Manor Health and Rehabilitation Center, has been working to increase immunization rates at the center for several years.

“Hospitals and nursing homes are often ‘ground zero’ for viruses and bacteria,” says Quaker. “But over 40% of all health care workers in America today have not had a flu shot.”

Flynn, Quaker and the care team at Rochester Manor were determined to do everything possible -- short of mandating flu shots -- to keep influenza out of their center. “I know that many states and facilities require employees to get flu shots, and of course we’d love a 100% participation rate, but making shots mandatory was not compatible with our management philosophy, or with New Hampshire law. So we had to come up with an effective way to incentivize employees.”

Over the years, the center had “tried everything,” Quaker reports. They sent out notices explaining the benefits of immunization. They offered the flu shots at no cost. They held drawings for cash rewards.

They tried free chocolate and Dunkin Donuts gift cards. “Everything worked...a little bit,” says Quaker. “We’d get three or four new people every time we offered an incentive. But it was a slow and painful process. I didn’t want to make flu shots mandatory. It just felt too confrontational to me.”

So how did Quaker finally achieve an 85% compliance rate? (or 88% if you count those staff that have allergies and have declined the shot for medical reasons)? “It was actually very simple,” she says. “I found the answer in a one-page company policy document.”

Signing this document, called “Informed Refusal of influenza Immunization” was standard procedure at Rochester Manor. The problem was, nobody seemed to be paying attention to what the document actually said – or its implications for employee salaries.

“Basically, our informed refusal document explains how important immunization is for our center – how it protects our vulnerable population of seniors. But it also warns employees that in the event our center does have an influenza outbreak, employees who chose not to be vaccinated may be shut out and prevented from working during the period of the outbreak by order of the center’s medical officer of health.

"In that case, any missed workdays would not be counted as sick leave, and the employee would not be eligible for pay.”

The policy also notes that unvaccinated employees will be required to pay for their own treatment costs, should they come down with the flu, and will be required to “take precautionary measures, for a prescribed time” before returning to work. “This policy exists for one reason: to protect our residents,” says Quaker.

She noted that once she had the policy in hand, and had reviewed it with immunization holdouts at the center, compliance increased dramatically. “People know now that we’re serious about protecting our patients and employees from influenza.

"And they know that if we have an outbreak here, unvaccinated staff members will not be allowed to work. Knowing that a flu outbreak could mean no paycheck has really driven the message home.”

The policy is working, Quaker reported – for everyone. “In the last 10 years, every single nursing home in our community has been closed due to a flu outbreak – except for us. We’ve been able to keep our doors open, keep our patients and families safe, and keep our staff working.“

Quaker does have a few immunization holdouts. “We do have some staffers with allergies, and some who have philosophical objections. We don’t force these employees to get flu shots, and of course we hope they don’t get sick. But the bottom line is that our patients come first.”

-- About Rochester Manor--Rochester Manor, a member of Revera Health Systems, offers both short and long-term rehabilitation and skilled nursing care as well as respite care and hospice care. The center recently unrelieved its new STAR (Specialized Therapy and Rehabilitation) unit for short-stay patients.